<?php
include ("header.php");
?>
<script type="text/javascript" src="jscripts/view.js"></script>
<script type="text/javascript" src="jscripts/calendar.js"></script>
<body id="form">


<div id="form_container">
<form id="form_158019" class="appnitro" method="post" action="new_register_submit.php">
<div class="form_description">
<h2>Organization Registration</h2>
<p>Fill out this form to share your Organization on Anteater Feeder</p>
</div>
<ul>

	<!-- Organization -->
	<li id="li_0"><label class="description" for="element_0">Organization Name</label>
		<span>
			<input id="element_0" name="org" class="element text large"
			value="" type="text" size = "20">
		</span>
	</li>
	<!-- Name -->
	<li id="li_1"><label class="description" for="element_1">Contact Person</label>
	<!-- First Name -->
		<span>
			<input id="element_1_1" name="first_name" class="element text" maxlength="255" size="8" value="" />
				<label>First Name</label>
		</span>
	<!-- Last Name -->
		<span>
			<input id="element_1_2" name="last_name" class="element text" maxlength="255" size="14" value="" />
				<label>Last Name</label>
			</span>
	</li>
	<!-- Phone Number -->
	<li id="li_2">
		<label class="description" for="element_2">Phone number </label>
			<span>
				<input id="element_2_1" name="phone_num1" class="element text"
				size="3" maxlength="3" value="" type="text"> -
				<label for="element_2_1">(###)</label>
			</span>
			<span>
				<input id="element_2_2" name="phone_num2" class="element text"
				size="3" maxlength="3" value="" type="text"> -
				<label for="element_2_2">###</label>
			</span>
			<span>
				<input id="element_2_3" name="phone_num3" class="element text"
				size="4"maxlength="4"value="" type="text">
				<label for="element_2_3">####</label>
			</span>
	</li>
	<!-- Fax Number -->
	<li id="li_21">
		<label class="description" for="element_21">Fax Number </label>
			<span>
				<input id="element_21_1" name="fax_num1" class="element text"
				size="3" maxlength="3" value="" type="text"> -
				<label for="element_21_1">(###)</label>
			</span>
			<span>
				<input id="element_21_2" name="fax_num2" class="element text"
				size="3" maxlength="3" value="" type="text"> -
				<label for="element_21_2">###</label>
			</span>
			<span>
				<input id="element_21_3" name="fax_num3" class="element text"
				size="4"maxlength="4"value="" type="text">
				<label for="element_21_3">####</label>
			</span>
	</li>
	<!-- Address -->
	<li id="li_3">
		<label class="description" for="element_3">Address </label>
		<div>
			<input id="element_3_1" name="street_address" class="element text large"
			value="" type="text">
			<label for="element_3_1">Street Address</label>
		</div>
		<div>
			<input id="element_3_2" name="line2" class="element text large"
			value="" type="text">
			<label for="element_3_2">Address Line 2</label>
		</div>
	
		<div class="left">
			<input id="element_3_3" name="city"
			class="element text medium" value="" type="text">
			<label for="element_3_3">City</label>
		</div>
	<!--  
		<div class="right">
			<input id="element_3_4" name="state"
			class="element text medium" maxlength="15" value="" type="text">
			<label for="element_3_4">State</label>
		</div>
	-->
		<div class ="left">
			<input id="element_3_5" name="zipcode" class="element text medium"
			maxlength="15" value="" type="text">
			<label for="element_3_5">Postal / Zip Code</label>
		</div>
	</li>
	<!-- website -->
	<li id="li_10"><label class="description" for="element_8">Website Address </label>
		<div>
			<input id="element_10" name="website" class="element text medium" type="text" maxlength="255" value="http://" />
		</div>
	</li>
	<!-- Email -->
	<li id="li_4">
		<label class="description" for="element_4">Email </label>
		<div>
			<input id="element_4" name="email" class="element text medium"
			type="text" maxlength="255" value="" />
		</div>
	</li>
	<!-- Organization type -->
	<li id="li_5">
		<label class="description" for="element_5">Organization Type </label>
		<div>
			<input class="element text small" id="element_5" name="category" type ="radio" value ="farm" />Farm<br>
			<input class="element text small" id="element_5" name="category" type ="radio" value ="farmers_market" />Farmer's Market<br>
			<input class="element text small" id="element_5" name="category" type ="radio" value ="community_garden" />Community Garden<br>
			<input class="element text small" id="element_5" name="category" type ="radio" value ="orchard" />Orchard<br>
			<input class="element text small" id="element_5" name="category" type ="radio" value ="csa" />CSA<br>
			<input class="element text small" id="element_5" name="category" type ="radio" value ="other" checked />Other<br>
		</div>
	</li>
	<!-- times-->
		<li id="li_6">
		<label class="description" for="element_6">Times available. </label>
		<div>
			<textarea id="element_6" name="times"
			class="element textarea medium"></textarea>
		</div>
		<p class="guidelines" id="guide_6">
			<small>
				Please enter the days of the week
			 	and times you are avaialable.
			 </small>
			</p>
	</li>
	<!-- Tree Info 
	<li id="li_7">
		<label class="description" for="element_7">Food Information</label>
		<div>
			<textarea id="element_10" name="tree_info" class="element textarea medium"></textarea>
		</div>
		<p class="guidelines" id="guide_10"><small>What kind of food do you have?</small></p>
	</li>
	<!-- Equipment
	<li id="li_8">
		<label class="description" for="element_8">Equipment available on site. </label>
		<span>
			<input id="element_8_1"	name="ladder" class="element checkbox" type="checkbox" value="1" />
			<label class="choice" for="element_8_1">Ladder</label>
			<input id="element_8_2" name="element_8_2" class="element checkbox" type="checkbox" value="1" />
			<label class="choice" for="extension_cord">Extension Cord</label>
		</span>
		<p class="guidelines" id="guide_8">
			<small>
				What equipment can you
				provide on site to help harvest?
			</small>
		</p>
	</li>
	<!-- Additional Information -->
	<li id="li_9"><label class="description" for="element_9">Additional information </label>
		<div>
			<textarea id="element_9" name="add_info" class="element textarea medium"></textarea>
		</div>
		<p class="guidelines" id="guide_9">
			<small>
				Is there anything other information
				you would like to add?
			</small>
		</p>
	</li>
		<!-- password
	<li id="li_11">
		<label class="description" for="element_11">Password </label>
		<div>
			<input id="element_11" name="password" class="elment text medium"
			type="password" maxlength="255" value="" />
		</div>
				<p class="guidelines" id="guide_11">
			<small>
				Create a password so that you may edit your information later.
			</small>
		</p>
	</li>
	-->
	<li class="buttons"><input type="hidden" name="form_id" value="158019" />

	<input id="saveForm" class="button_text" type="submit" name="submit"
		value="Submit" /></li>
</ul>
</form>
</div>
</body>
<?php
include ("footer.php");
?>